Appointment Request
If you are having a dental emergency, please make your appointment by calling our office at
757-497-4825
.
When requesting an appointment, please keep in mind our office hours are:
Monday 8am - 6pm
Tuesday 8am - 5pm
Wednesday 8am - 6pm
Thursday 8am - 5pm
Friday 8am - 2pm (we are only open the first Friday of the month)
Name
Phone
Email
Preferred Method of Contact
Phone
Email
Reason for Appointment
Preferred Provider
No Preference
Dr. Fernandez
Dr. Cox
Kelly
Melanie
Grace
Julie
Requested Day of Week
Monday
Tuesday
Wednesday
Thursday
or Date
Requested Time of Day
Early as Possible
10am - 1pm
2pm - 4pm
Late as Possible
Whom may we thank for referring you?
Friend
Relative
Co-Worker
Insurance
Referring person
We will contact you by your stated preferred method when your request has been fulfilled.
We look forward to taking care of you